Monday, May 16, 2011

Public heath issues

Libertarians will not be pleased with the New Scottish government since their first declared act will be to introduce a minimum price for alcohol of 50p per unit. Of all places in the world, Scotland is one of the most addicted to alcohol. Life expectancy in Scotland is lower than in the rest of the UK and drinking certainly plays a part in this. Objections have been made that this punishes the poorer drinker, but that is precisely why it is being introduced; it is the poorer drinker who is suffering from alcoholism, liver disease and domestic abuse. My own view is that while you have a national health service, with someone else picking up the tab for your bad behavior, then the insurer of last resort is fully justified in limiting his outgoings by whatever means.

Exactly the opposite problem is happening in Germany. There is a Federal ban on smoking in Federal buildings, and most of the States have introduced bans on smoking in restaurants, bars and pubs. However, a recent survey found that four out of five restaurants and pubs use legal loopholes to get round the smoking ban.

In the UK cigarette manufacturers are using psychological ploys to keep people smoking. There are selling cigarettes in packets of 14. Although these packets cost more per cigarette than packets of 20, it means that poorer smokers will have a smaller capital outlay per packet purchased. They have also determined that 14 cigarettes a day is a reasonable target to aim for poor smokers.

From 2012 large stores will no longer be able to display cigarettes for sale and even small tobacconists will be unable to do so from 2015.

I imagine that most right wing Americans are appalled by the proposed new health plan in Vermont. It would abolish most insurance plans and introduce a single payer. Apparently one in five people in Vermont is without health insurance. It is claimed that the Vermont plan would result in cost savings of 25% over 10 years by administrative simplification, the introduction of no-fault malpractice,, the elimination of perverse incentives like fees for service and the insulation of major healthcare decisions from politics. All I can say is ,”Good luck!”

Another current issue is the contribution of pharmaceutical companies to medical associations.. Many medical societies and non-profit disease awareness organizations receive much of their funding from drug and device manufacturers. Millions of dollars are involved. Although not necessarily applied primarily to sell their wares, these monies can easily taint the continuing medical education that they supposedly support.

However, doctors and nurses are reluctant to pay for CME activities themselves. Although most doctors recognize the potential for bias that drug company funded CME introduces, most underestimate exactly how much money the drug companies are putting in and how biased they are. Recently regulations about drug company funding have become more stringent. Applicants for EHA tell me it is much more difficult to obtain funds from Big Pharma now.
In other areas there is news about excess winter deaths in cold weather. Studies have shown that excess winter deaths in the UK are three times higher in the coldest houses compared to the warmest houses. Fuel poverty is defined as having to spend 10% or more of a household’s net income on heating the house to an adequate level. In 2008 it was estimated that 18% of households suffered from fuel poverty. The most easy to influence factor is house insulation and the 2011 Energy Bill seeks to produce a strategy to insulate enough homes to tackle fuel poverty.

Fewer children in England and Wales are dying violently. Numbers have fallen substantially in the past 30 years. From 1974 to 2008 the numbers of infants who died from assault fell from 5.6 per 100,000 to o.7 per 100,000. During the same period the death rate in all children from assault fell from 0.6 to 0.2 per 100,000. However, the death rate for 15-19 year old boys from assault has risen. Presumably this reflects gang warfare in inner cities.

One of the great successes of British Public Heath has been the reduction of road accidents as a cause of death. I remember in the 1950s when there were fewer than a million cars on the roads that there were over 7000 deaths on the roads annually. Today with 20 million+ vehicles on the roads, there are just over 2000 road deaths. Road deaths have been truly terrible in the past. During the time that 48,000 American soldiers were killed in World War I, 14,000 civilians were killed on American roads. In France road deaths have fallen from 16,000 to 4000 in 40 years.

Worldwide, nearly 1.3 million people are killed annually on the roads. It is the commonest cause of death among young people aged 15-29.. A quarter of these deaths occur in India and China. Brazil and Russia are other countries with high death rates. The WHO is keen to introduce a raft of measures that have proved successful in Britain, France, Australia and Sweden, including enforcement of traffic regulations, the wearing of seat belts, speed limits, motor cycle helmets and avoiding drink driving.

1 comment:

Burke said...

"My own view is that while you have a national health service, with someone else picking up the tab for your bad behavior, then the insurer of last resort is fully justified in limiting his outgoings by whatever means."

Note that once you choose to force people to participate in a social program, it necessarily leads to forcing them in other ways.

Once we violate the principle that people should deal by trade instead of by force, there is no end to it.

Why can't you force people to go on diets, for example?